Salter-Harris fractures: Difference between revisions
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==Types== | ==Types== | ||
===Type 1 | ===Type 1 (Slip)=== | ||
* slip through epiphysis | * slip through epiphysis | ||
* mostly in infants and todlers | * mostly in infants and todlers | ||
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* good prognosis | * good prognosis | ||
===Type 2 | ===Type 2 (Above)=== | ||
* fx thru\above metaphysis. fx thru hypertrophic zone of physis and then above thru metaphysis. | * fx thru\above metaphysis. fx thru hypertrophic zone of physis and then above thru metaphysis. | ||
* most common type of fx | * most common type of fx | ||
* segment of metaphyseal bone called Thurston Holland fragment | * segment of metaphyseal bone called Thurston Holland fragment | ||
===Type 3 | ===Type 3 (Below)=== | ||
* intraarticular fx | * intraarticular fx | ||
* relatively rare | * relatively rare | ||
* the greater displacement, greater chance of vasc supply compromise and greater chance of growth disturbance | * the greater displacement, greater chance of vasc supply compromise and greater chance of growth disturbance | ||
===Type 4 | ===Type 4 (Both)=== | ||
* starts at articular surface thru epiphysis thru physisi thru metaphys | * starts at articular surface thru epiphysis thru physisi thru metaphys | ||
* mostly at distal humerus | * mostly at distal humerus | ||
===Type 5 | ===Type 5 (Crush)=== | ||
* most rare type | * most rare type | ||
* highest chance of growth arrest | * highest chance of growth arrest | ||
Revision as of 23:47, 7 June 2011
Background
- is composed of proliferating cartilage cells and lacks inherent strength and therfore easily damaged.
- injury can happen at any age but most common during period of rapid growth
- if missed- prematume closure and bone growth arrest
- most common after age 10
- more in boys- more active and later skeletal maturity than girls
- funtion of physis is for rapid longitudinal bone growth
- distal radius most common site
- ligaments stronger than bones in kids- more likely to fx than sprain
- repetitive stress injury can also cause it
- suspect if point tenderness over physis and neg xray
Types
Type 1 (Slip)
- slip through epiphysis
- mostly in infants and todlers
- by shearing torsion avulsion
- fx thru hypertrophic zone with growing cells remaining on the epiphysis in continuity with blood supply
- no osseous fx
- good prognosis
Type 2 (Above)
- fx thru\above metaphysis. fx thru hypertrophic zone of physis and then above thru metaphysis.
- most common type of fx
- segment of metaphyseal bone called Thurston Holland fragment
Type 3 (Below)
- intraarticular fx
- relatively rare
- the greater displacement, greater chance of vasc supply compromise and greater chance of growth disturbance
Type 4 (Both)
- starts at articular surface thru epiphysis thru physisi thru metaphys
- mostly at distal humerus
Type 5 (Crush)
- most rare type
- highest chance of growth arrest
- compression crushes cells of zone of reserve and proliferation
- minimal or no displacement of epiphysis
- usually at knee or ankle by severe adduction abductn
- usually dx in retrospect once bone growth abnormality already seen
Mneumonic
S 1- Slipped (thru epiphysis)
A 2- Above (epiphysis c metaphysis fx)
L 3- Lower (thru epiphysis)
T 4- Through (epi and meta)
R 5- Rammed (growth plate crushed)
(*reference joint is below*)
Diagnosis
X rays
- can have acute fx ang neg x ray- look for point tenderness over physis
- type 2-3-4 can see on xray
- type 1 - 5 can be occult
- type 5 may have effusion
- can also use stress radiography
Treatment
- type 1 2- splint
- type 3-4- surg, probably ORIF
- type 5- ortho, casting and nonwt bearing